Oral-Motor/Oral-Sensory Therapy

Christine Yannone, M.S., CCC/SLP

The development of our oral structures and their functions is a complex process.
Mastery of oral abilities allows us to eat and drink a variety of foods and liquids as
well as produce the necessary sound sequences to create words and sentences. Oral
development involves acquiring skills that are movement-based as well as sensorybased.
For example, to produce the /d/ sound, one must elevate the tongue tip to touch the
roof of the mouth right behind the teeth and to then coordinate a 'flick' of the tongue
up against the roof of the mouth while concurrently moving the lips, teeth, cheeks,
and vocal cords. This split second process of coordination requires both motor skills
(the strength to move the tongue) and sensory processing abilities (awareness and
timing of tongue placement). Preparing food to swallow requires very similar motor
and sensory abilities. Children develop these skills through repeated oral experiences
starting at birth. Such experiences include, but are
not limited to, mouthing a variety of objects,
babbling, sucking, eating, and making sounds such
as raspberries.
For the child who requires tube feedings, these oral
experiences can be disrupted or non-existent. Due
to medical complications, tube-fed children often
experience invasive and/or painful oral procedures.
These procedures often interfere with normal oral
sensory-motor
development.
Structural
abnormalities (e.g. cleft palate) and neurological
immaturity or abnormalities may also result in an
aversion to typical oral experience. Often a series
of negative oral experiences, not an isolated
incident, alters the course of normal development.
This article will briefly review assessment of oralmotor abilities and will then describe the
therapeutic process to address oral sensory-motor
issues.
Typical oral-motor development occurs in a predictable progressive pattern. Both
strength and coordination must be achieved in order to master oral efficiency in both
speech and feeding abilities. Speech and feeding skills typically develop

concurrently. There is obvious overlap in the oral structures involved in both of these
areas. However, there is controversy about the interconnected nature of skill
acquisition for feeding and speech. For each of these areas, there is a successive
pattern of typical development that leads to skill mastery. These typical patterns of
development guide the assessment and therapeutic processes.
Assessment
When evaluating oral-motor abilities, the appearance and movement of the oral
structures are assessed. Oral structures include the jaw, tongue, lips, teeth, palate,
cheeks, and throat. The shape, size, color, and growth are observed. Differences in
development are noted which may effect oral-motor abilities. In addition to the
structures, the adequacy of oral functioning is evaluated by watching how the
structures move. A clinician engages the child in a variety of oral activities that may
include speaking, eating, imitating, mirror play, bubbles, whistles, and/or singing.
The quality of movement is evaluated by observing the rhythm, stability, efficiency
and separation of oral movements. In addition, muscle tone and sensory
processing are observed. If any of these characteristics appear to impact the child's
ability to speak and/or eat, oral sensory-motor therapy may be recommended.
All speech pathologists are trained to evaluate oral structures and their function for the
purpose of speech production. However, only some speech pathologists and only
some occupational therapists are trained to assess and treat oral structures and their
function as it relates to feeding. In choosing a clinician, it is important to inquire
about these qualifications.
Treatment
When a child begins oral-motor therapy, a therapist will often engage the child in an
activity that stimulates the whole body to prepare the child for the more challenging
oral-motor work. This may involve bouncing, swinging, jumping, etc. The whole
body stimulation facilitates a calm and awake state. This is similar to what people
experience through exercise. In exercising, we ready our bodies to deal with the
stresses of daily living by physically preparing our body to cope with stressful
situations. Whole body stimulation seeks to prepare the child for optimal learning
during challenging oral activities by facilitating a relaxed and alert state.
The purpose of oral sensory-motor therapy is to establish appropriate oral experiences
related to feeding and/or speech. Therapy is broken down into a number of goals,
some of which may be worked on simultaneously. One of the first goals of therapy is
to increase the child's awareness of oral structures and how they work. This is
accomplished by educating the child about their oral structures. While stimulating the

structures with fingers, mouth brushes, or toys the adult labels the place of activity for
the child; "I'm touching your lips." Labeling can be incorporated into a wide variety
of activities such as making silly faces in the mirror, singing a song with each verse
focusing on a part of the mouth, washing the face and brushing the teeth, or imitative
games.
Another initial goal may be to normalize the child's oral tactile sensitivity. This
means teaching the child to tolerate touching both on the face and in the mouth with a
variety of textures (bumpy, smooth, soft, hard, etc.) and temperatures. This is done by
gradually providing the child with appropriate sensory experiences. These
experiences may include mouthing of toys, oral massage, vibration, mouth brushing,
face washing, and whistle and bubble blowing. The combination of activities is
dependent upon the child's specific needs. Some children are very sensitive (hypersensitive) to oral touch, while others lack in sensitivity (hypo-sensitive). The goal is
for the child to be both aware of sensation and tolerant of a variety of sensations.
Normalizing sensitivity also includes facilitation of an appropriate gag reflex. When
an infant is born, they will gag when varied textures are introduced into the mouth.
This is a protective response that is designed to prevent choking. Typically, the gag
reflex is fully 'integrated' by approximately 24 months of age. This means that the
sensitive spot that triggers a gag moves to the back of the throat. This movement
allows children to develop the ability to eat a wide variety of food textures. (Most of
us have a gag reflex that can be triggered by touching the back of the throat with an
object.) Often times, children who have developed oral sensory-motor difficulties will
continue to have a forward gag reflex or an over-sensitive gag reflex. For these
children, gradual, guided oral sensory-motor experiences are utilized to facilitate gag
integration.
Oral stimulation activities can be modified to meet the child's level of development.
For example, rattles may be used for mouthing for a toddler while popular figurines
might be used for an older school age child. While engaged in an oral activity, the
adult describes the characteristics of the experiences. These activities can often be
overwhelming for children. It is important to move slowly as well as to provide the
child with safe models of how they might engage in the activity. For example, while
mouthing a NUK brush the adult says, "Oh, this brush feels bumpy. I can lick it with
my tongue. You can lick it with your tongue too."
An important part of oral-motor development involves coordination of the oral
structures and their separate and precise oral movements. This allows for mature
feeding patterns and speech sounds to develop. To accomplish this, therapy addresses
oral muscle strength as well as differentiation of oral movements. Differentiation
means that the movement of oral structures occurs independent of one another. By

providing the child with repetitive oral-motor experiences based upon the normal
sequence of development for eating and/or speech, strength and differentiation are
facilitated. Goals are picked according to the child's current level of functioning and
the next developmental step. Goals are accomplished through typical oral activities.
For example if lip strength were a goal, activities might include: lip smacking,
smiling, puckering, blowing kisses, blowing bubbles, using a straw, raspberry noises,
etc. These activities can all be modified to fit the child's level of interest and age.
As a tube-fed child often has a history of adverse oral experiences and may have
developed atypical oral-motor survival strategies, it is sometimes necessary to
eliminate abnormal oral movement patterns and replace them with more normal
patterns of movement. This involves assessing the whole body as it performs oralmotor tasks. Initially, therapists may need to focus on body positioning in order to
provide the child with a stable base from which to initiate oral movement. For
example, it is really difficult to coordinate breathing and jaw movements when seated
in a slouched, hunched over position. Aligning the pelvis, spine, and head allows the
chest and jaw to move more easily and efficiently. Abnormal patterns are often
learned coping strategies, and therefore, they can be difficult to change. Although
initially more difficult, it is important to promote practice of the correct movement in
order to facilitate long term positive effects.
Oral-motor development is a complex process that involves the whole body and
sensory systems. It is an important foundation for both speech and feeding skills. In
addition to therapeutic sessions, oral sensory-motor therapy should include a home
program. Repetitive, reinforcing oral experiences in a variety of environments will
facilitate long-term positive effects. The most beneficial therapeutic program
incorporates the child and parent in the process.